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Radiation-Induced Lung Disease
Sonia L. Betancourt-Cuellar, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Radiation-induced lung disease (RILD)
          • Synonyms

            • Radiation pneumonitis
            • Radiation fibrosis
          • Definitions

            • Radiation therapy (RT) uses ionizing radiation to control cell growth by damaging DNA of cancerous tissue leading to cellular death
              • Treatment/palliation of thoracic neoplasms: Lung, breast, esophageal cancers; thymic epithelial neoplasms; lymphoma; malignant pleural mesothelioma
            • Conventional 2DRT uses 2 parallel beams with opposite directions (anteroposterior and posteroanterior)
              • Currently reserved for palliative treatment of painful bone metastases and hemoptysis
            • New RT techniques developed to ↑ dose to target lesion and ↓ dose to surrounding structures
              • 3D image reconstructed from CT data used to determine target volume; multiple beams used to conform to target and deliver maximal radiation to neoplasm
                • 3D conformal RT (3DCRT): Each radiation beam shaped to fit profile of target volume (previously, radiation treatment matched height and width of target lesion)
                  • 4D conformal RT uses respiratory gating
                • Intensity-modulated RT (IMRT): Next generation of 3DCRT; allows more precise conformation to 3D shape by modulating intensity of radiation beam in multiple small volumes
                • Stereotactic body RT (SBRT): Small number of fractions (hypofractionated) with higher dose per fraction to treat early non-small cell lung cancer (NSCLC)
              • Proton therapy: Use of protons as radiation source
                • Radiation delivered to certain depth with minimal dose beyond target lesion; useful for treatment of recurrent previously irradiated tumors, central tumors, and tumors close to critical structures

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Benveniste MF et al: Recognizing radiation therapy-related complications in the chest. Radiographics. 39(2):344-66, 2019
                                      2. Zhu X et al: Radiation-induced lung injury patterns and the misdiagnosis after SBRT of lung cancer. Eur J Radiol. 121:108708, 2019
                                      3. Benveniste MF et al: Lung cancer: posttreatment imaging: radiation therapy and imaging findings. Radiol Clin North Am. 56(3):471-83, 2018
                                      4. Febbo JA et al: Stereotactic body radiation therapy for early-stage non-small cell lung cancer: a primer for radiologists. Radiographics. 38(5):1312-36, 2018
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Radiation-induced lung disease (RILD)
                                              • Synonyms

                                                • Radiation pneumonitis
                                                • Radiation fibrosis
                                              • Definitions

                                                • Radiation therapy (RT) uses ionizing radiation to control cell growth by damaging DNA of cancerous tissue leading to cellular death
                                                  • Treatment/palliation of thoracic neoplasms: Lung, breast, esophageal cancers; thymic epithelial neoplasms; lymphoma; malignant pleural mesothelioma
                                                • Conventional 2DRT uses 2 parallel beams with opposite directions (anteroposterior and posteroanterior)
                                                  • Currently reserved for palliative treatment of painful bone metastases and hemoptysis
                                                • New RT techniques developed to ↑ dose to target lesion and ↓ dose to surrounding structures
                                                  • 3D image reconstructed from CT data used to determine target volume; multiple beams used to conform to target and deliver maximal radiation to neoplasm
                                                    • 3D conformal RT (3DCRT): Each radiation beam shaped to fit profile of target volume (previously, radiation treatment matched height and width of target lesion)
                                                      • 4D conformal RT uses respiratory gating
                                                    • Intensity-modulated RT (IMRT): Next generation of 3DCRT; allows more precise conformation to 3D shape by modulating intensity of radiation beam in multiple small volumes
                                                    • Stereotactic body RT (SBRT): Small number of fractions (hypofractionated) with higher dose per fraction to treat early non-small cell lung cancer (NSCLC)
                                                  • Proton therapy: Use of protons as radiation source
                                                    • Radiation delivered to certain depth with minimal dose beyond target lesion; useful for treatment of recurrent previously irradiated tumors, central tumors, and tumors close to critical structures

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • Nuclear Medicine Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Natural History & Prognosis

                                                                  • Treatment

                                                                    DIAGNOSTIC CHECKLIST

                                                                    • Consider

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Benveniste MF et al: Recognizing radiation therapy-related complications in the chest. Radiographics. 39(2):344-66, 2019
                                                                          2. Zhu X et al: Radiation-induced lung injury patterns and the misdiagnosis after SBRT of lung cancer. Eur J Radiol. 121:108708, 2019
                                                                          3. Benveniste MF et al: Lung cancer: posttreatment imaging: radiation therapy and imaging findings. Radiol Clin North Am. 56(3):471-83, 2018
                                                                          4. Febbo JA et al: Stereotactic body radiation therapy for early-stage non-small cell lung cancer: a primer for radiologists. Radiographics. 38(5):1312-36, 2018